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What To Do About Bloating With Hashimoto's Hypothyroidism

Learn what to do about some of the leading causes of bloating related to Hashimoto's in this article.
What To Do About Bloating With Hashimoto's Hypothyroidism
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Many things can cause gut problems. In the past, doctors were quick to blame stomach upset on stress. But, with more focus on issues like bloating, gas, and constipation, we know now that stress is not the only culprit. 


People with Hashimoto's thyroiditis often experience painful bloating, a condition where your belly feels full and tight, often due to gas. However, the cause of bloating is not always straightforward. People might confuse bloating with other reasons like abdominal wall laxity or looseness. Sometimes, Hashimoto's bloating is related to constipation that results from an underactive thyroid, but often it is more complex than that.


Ahead, an exploration of some of the leading causes of bloating in Hashimoto's and what you can do about it. After all, knowing what is behind your bloating can help you take proactive steps toward treating it.


Causes of bloating

Bloating occurs when the gastrointestinal tract becomes filled with air or gas. This can be caused by something as simple as the food you eat or food intolerance (like lactose intolerance or gluten sensitivity). Below, are some other possible causes of bloating. 



Constipation is one common cause of bloating. You may experience constipation without knowing it. Constipation is often thought of as having few to no bowel movements, but constipation may also be regular bowel movements that require straining to start or finish, stool that looks like rocks and pebbles, or not feeling empty after a bowel movement. One common cause of bloating is constipation. The longer that stool stays in the colon, the more time bacteria have to ferment what's there, resulting in gas and bloating.


Small intestinal bacterial overgrowth (SIBO)

Small intestinal bacterial overgrowth, or SIBO, for short, is a condition where too many bacteria that usually belong in the large intestine migrate to the small intestine. The type of bacteria that migrate feeds off of simple sugars and carbohydrates in your diet. When they consume these sugars, they emit excess gas that can accumulate in your small intestine, causing you immense abdominal discomfort. 



Gastroparesis is a condition in which the stomach cannot empty itself of food normally, which can cause bloating, nausea, and even bowel blockage. Symptoms include heartburn, nausea, vomiting, and feeling full quickly when eating. Treatments include medications and possibly surgery. 


Gynecological conditions

Sometimes problems with your ovaries or uterus may cause bloating. Make sure you never skip your annual pelvic exam.

How Hashimoto's hypothyroidism may contribute to bloating


Hashimoto's thyroiditis is an autoimmune disease in which the immune system attacks the thyroid gland tissues. Over time, this causes chronic inflammation and leads to hypothyroidism or an underactive thyroid gland that does not produce enough thyroid hormone. Autoimmune diseases are very complex to understand, and there are certainly still mysteries behind them. However, research suggests that autoimmune diseases often start in the gut. After all, most of your immune system lives in your digestive tract. 


Slower gut motility

Because thyroid hormones help regulate your gastric motility, it can take longer for food to move throughout your gastrointestinal system.  When food sits in your stomach for too long, it can cause acid reflux and burping. It also makes you feel full for a long time. Also, Hashimoto's may cause low stomach acid, making it harder to digest foods properly, especially protein-rich food. Low stomach acid can also lead to nutrient depletion and food sensitivities.  Further down your digestive tract, slower gut motility can cause constipation, which can exacerbate your bloating symptoms.

Small Intestinal Bacterial Overgrowth (SIBO)

SIBO, as mentioned above, is one possible cause of bloating. Hashimoto's patients often experience altered gastrointestinal motility which can lead to the development of SIBO. Patients who have Hashimoto's or hypothyroidism and experience chronic GI symptoms should talk with their healthcare provider about the possibility of SIBO. 


Common symptoms of SIBO include:

  • Bloating
  • Loss of appetite
  • Unintentional weight loss
  • Diarrhea
  • Belching
  • Flatulence
  • Malnutrition


To diagnose SIBO, your doctor may order a breath test that measures the amount of hydrogen and methane in your breath after drinking a mixture of water and glucose. A rise in these two gases can indicate too much bacteria in the small intestine. Although breath tests are less invasive, the gold standard for diagnosing SIBO is to get a fluid sample from your digestive tract through an endoscopic procedure

Research shows that both antibiotics and probiotics can be effective in the management of SIBO.


How to manage bloat with Hashimoto's hypothyroidism


Make lifestyle behavioral modifications

Certain lifestyle factors can put you at greater risk for bloating. So, one of the first ways to prevent bloating is to avoid the following behaviors.

  • Avoid eating too much or too quickly
  • Avoid chewing gum
  • Avoid swallowing air when drinking or eating
  • Avoid smoking cigarettes
  • Avoid inactivity


Proper nutrition is also a crucial part of our lifestyle and is critical in curbing bloating. After all, people usually bloat after eating a meal, and often it is what's in your food that causes the discomfort. One of the best ways to identify foods that trigger bloating is to try a temporary elimination diet. With an elimination diet, you eliminate foods and then reintroduce them slowly to determine your specific dietary triggers. This process can be incredibly beneficial for people living with autoimmune conditions like Hashimoto's. 


Try the autoimmune protocol, or AIP diet

The autoimmune protocol (AIP diet) is helpful for most people with an autoimmune condition like Hashimoto's. This temporary elimination diet can help you identify what foods are easy on your system and what foods wreak havoc. 


The AIP is a rigorous elimination diet. For the first several weeks, you eat only easy-to-digest foods while eliminating common food triggers like gluten and grains, dairy, sugar, soy, eggs, nuts and seeds, and nightshade vegetables. Processed and refined sugars, oils, and caffeine are off-limits. 


After the elimination phase, you intentionally reintroduce one food group at a time, slowly, to determine which foods best support your body. In this experimental diet, you want to allow your body enough time to reset before you begin any reintroductions. Giving yourself enough time will enable you to feel noticeable differences in how you feel physically and mentally.  


Try a low-FODMAP diet

Another diet that can help relieve bloating is the FODMAP diet. FODMAP stands for fermentable oligo-, di-, mono-saccharides, and polyols, which are certain carbohydrates found in foods like wheat and beans infamous for triggering uncomfortable digestive symptoms. In a low-FODMAP diet, you remove these foods from your diet. 


  • Oligosaccharides include wheat, rye, legumes, and some fruits and vegetables like garlic and onions.
  • Disaccharides include some dairy products that contain lactose like milk, yogurt, and soft cheese. 
  • Monosaccharides include various fruits and sweeteners that contain fructose like figs, mangoes, honey, and agave nectar.
  • Polyols include certain fruits and vegetables like blackberries and lychee and some low-calorie sweeteners.


FODMAPs draw water into your intestines, which can lead to diarrhea. However, they also provide fuel for bacteria that release gases into your system. Many studies confirm that a low FODMAP diet can improve symptoms and quality of life in people with IBS, IBD, ulcerative colitis, and Crohn's. 


However, a low-FODMAP diet is not for everyone as most FODMAP foods are prebiotics, supporting the growth of good gut bacteria. We recommend you consult with a thyroid doctor or thyroid nutritionist to determine the right health plan for your specific needs.


Consider over-the-counter medications

Besides taking your regular thyroid medication, you can also treat symptoms of bloating with over-the-counter medications that help relieve gas, like simethicone. However, if your symptoms are persistent or you continually rely on medication to reduce bloating, it is time to see your doctor.


Explore natural remedies

While there is not strong scientific evidence for natural, alternative remedies for bloating, many people share that peppermint, ginger, cloves, and chamomile help soothe their guts, anecdotally. Some people also add apple cider vinegar to their beverages or take activated charcoal supplements before and after meals to improve digestion.


Try alternative medicine therapies

Acupuncture is alternative medicine method that may support digestive discomforts. Acupuncture can affect the internal organs by stimulating the somatic nervous system. While scientific studies show conflicting results for the effectiveness of acupuncture for irritable bowel syndrome,  some evidence shows that it may help control digestive symptoms like bloating.


When to see your doctor about bloating


Don't let bloating interfere with your quality of life! Excessive burping, passing gas, and bloating often resolve on their own or with simple lifestyle modifications. However, if your bloating doesn't improve after making simple changes consult your healthcare provider, especially if you also notice:


  • Diarrhea
  • Persistent or severe abdominal pain
  • Bloody stools
  • Changes in the color or frequency of stools
  • Unintended weight loss
  • Chest discomfort
  • Loss of appetite or feeling full quickly


These signs and symptoms could signal an underlying digestive condition, and it may be time to partner with a professional to determine the best treatment to support your specific needs. 

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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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